Liggins Institute, University of Auckland, Auckland, New Zealand
Paediatric and Congenital Cardiac Service, Starship Children's Health, Auckland, New Zealand.
BMJ Open. 2019 Aug 18;9(8):e030506. doi: 10.1136/bmjopen-2019-030506.
The aim of this study was to conduct New Zealand-specific research to inform the design of a pulse oximetry screening strategy that ensures equity of access for the New Zealand maternity population. Equity is an important consideration as the test has the potential to benefit some populations and socioeconomic groups more than others.
New Zealand has an ethnically diverse population and a midwifery-led maternity service. One quaternary hospital and urban primary birthing unit (Region A), two regional hospitals (Region B) and three regional primary birthing units (Region C) from three Health Boards in New Zealand's North Island participated in a feasibility study of pulse oximetry screening. Home births in these regions were also included.
There were 27 172 infants that satisfied the inclusion criteria; 16 644 (61%) were screened. The following data were collected for all well newborn infants with a gestation age ≥35 weeks: date of birth, ethnicity, type of maternity care provider, deprivation index and screening status (yes/no). The study was conducted over a 2-year period from May 2016 to April 2018.
Screening rates improved over time. Infants born in Region B (adjusted OR=0.75; 95% CI 0.67 to 0.83) and C (adjusted OR=0.29; 95% CI 0.27 to 0.32) were less likely to receive screening compared with those born in Region A. There were significant associations between screening rates and deprivation, ethnicity and maternity care provider. Lack of human and material resources prohibited universal access to screening.
A pulse oximetry screening programme that is sector-led is likely to perpetuate inequity. Screening programmes need to be designed so that resources are distributed in the way most likely to optimise health outcomes for infants born with cardiac anomalies.
This study was approved by the Health and Disability Ethics Committees of New Zealand (15/NTA/168).
本研究旨在开展新西兰特定研究，为脉搏血氧仪筛查策略的设计提供信息，以确保新西兰产妇人群享有公平的服务机会。由于该检测可能使某些人群和社会经济群体比其他人群受益更多，因此公平性是一个重要的考虑因素。
新西兰人口种族多样，拥有以助产士为主导的产妇服务体系。新西兰北岛三个地区卫生局所属的一家四等医院和一家城市一级分娩单位（区域 A）、两家地区医院（区域 B）和三家地区一级分娩单位（区域 C）参与了脉搏血氧仪筛查的可行性研究。这些地区的家庭分娩也包括在内。
共有 27172 名符合纳入标准的婴儿，其中 16644 名（61%）接受了筛查。对所有胎龄≥35 周的健康新生儿收集了以下数据：出生日期、种族、产妇护理提供者类型、贫困指数和筛查情况（是/否）。该研究于 2016 年 5 月至 2018 年 4 月期间进行了为期 2 年。
筛查率随时间推移而提高。与出生在区域 A 的婴儿相比，出生在区域 B（调整后的 OR=0.75；95%CI 0.67 至 0.83）和 C（调整后的 OR=0.29；95%CI 0.27 至 0.32）的婴儿接受筛查的可能性较小。筛查率与贫困程度、种族和产妇护理提供者之间存在显著关联。缺乏人力和物质资源使得无法普及筛查。
以部门为主导的脉搏血氧仪筛查方案可能会使不公平现象长期存在。筛查方案的设计需要确保资源分配方式最有可能优化患有心脏异常的新生儿的健康结果。
本研究已获得新西兰健康和残疾伦理委员会（15/NTA/168）的批准。
